Medication warnings
Certain veterinary medications for other conditions may seriously affect diabetic patients. This list is provided because some of these medications don't mention their side effects on diabetics in their literature. Many drugs used in veterinary medicine are also used in human medicine under a differently-trademarked name. Learning the human pharma name (if applicable) or generic name of the drug (same in veterinary & human medicine) can often give you additional information regarding possible side effects and how the drug may affect patients with diabetes. Human pharma drugs provide this information--for some reason, veterinary drugs don't always. If you are considering alternative or herbal medicine for your diabetic pet, see also Alternative medication warnings. Warning: Can Be Fatal to Diabetics and Non-Diabetics *'Xylitol', a common artificial sweetener, lowers blood sugar dangerously in dogs and sometimes humans, possibly also cats. Some prescription and over-the counter medications, including vitamins and supplements which are made for human use contain Xylitol. Reading labels thoroughly and asking your vet can prevent needless tragedies. Warnings: May raise blood glucose levels Heartworm and flea/tick prevention *HeartwormPetTalk.com-DiethylcarbamazineMerck Veterinary Manual Antihelmintics-Miscellaneous Antihelmintics-DiethylcarbamazinePetTalk.com-IvermectinPetTalk.com-MilbemycinMerck Veterinary Manual-Heartworm Disease-MilbemycinMerck Veterinary Manual-Antihelmintics-Macrocyclic Lactones-Ivermectin and flea/tick prevention medications are known to produce temporary high blood glucose levels in some diabetic dogs. In the affected animals, glucose levels return to normal a few days after the medication is used--loss of control being temporary. Just as all diabetics are not troubled with post-prandial spikes or dawn phenomenon, not all diabetic pets react to these medications in this way. No pharmaceutical company's products of this type contain advisories regarding the temporary elevation of blood glucoseHeartworm Disease in Dogs: An Update (Prevension)-WSAVA 2005. Heartworm Prevalence of Heartworm WorldwideFeline Heartworm-WSAVA2003 is a global problem, with areas on all continents except Antarctica affected and is a disease that is far easier to prevent than to cure. It can affect both cats and dogsHeartworm Society-Dogs vs CatsHeartworm Society-Canine Heartworm DiseaseHeartworm Society Feline Heartworm Disease. Should your pet be affected by this, a talk with your vet is in order. Increasing insulin doses to counter this temporary situation may cause hypoglycemia once the systemic medication level has lowered. The phenomenon also does not mean your pet has ceased to respond to the insulin you currently use. Since there are no formal label warnings, he/she needs to be aware that there are temporary side effects for these drugs which apply to some diabetics. *The same is true for flea and tick removal products, both professional and over the counter; they are also capable of producing this unwanted effect after use in some diabetic animals. Other Medications Epinephrine, or adrenalinPetTalk.com-Epinephrine, is a hormone present in all of us; most medical literature refers to it simply as the "fight or flight" hormone. It is what gives one that "extra boost" when needed to either escape danger or stand one's ground. A common medical use of epinephrine is to combat severe allergic/asthmatic reactions. Many people with life-threatening reactions to things like bee stings, etc., are never without their EpiPen. It's a pre-loaded injection of epinephrine to be used in an emergency. When someone with diabetes needs treatment with epinephrine, it counters the effects of the insulin and hyperglycemia is the resultEpinephrine/Adrenalin--Effect on DiabetesPetPlace.com-Insulin-Precautions & Side Effects. *'Nicotinic Acid' or Niacin, given to lower cholesterol. *'Phenobarbital'PetTalk.com-Phenobarbital and phenytoin (Brand name for phenytoin is Dilantin), commonly used in treating epilepsy and other nervous system disorders. *'Thyroid medications'PetTalk.com-LevothyroxineNiacin. Phenobarbital, Dilantin, Thyroid Medications & Diabetes used as replacement hormone therapy for those with insufficient thyroid production or who have had the glands removed. *'Carbamazepine' AKA Atretol, Carbatrol, Epitol, Equetro, Tegretol, Apo-Carbamazepine, Novo-Carbamaz, Nu-Carbamazepine, Taro-Carbamazepine-also used for treatment of epilepsy may cause increased urine glucose levelsUS National Institutes of Health-Carbamazepine. *'Phenothiazines'-many generic and brand names at this linkUS National Institutes of Health-Phenothiazines-may reduce the blood-glucose lowering effect of insulinRx.com. Also see below under diuretics/heart medications for some diuretics which can cause hyperglycemia. Contraindicated: May complicate or even promote diabetes Steroids *Oral or injected steroidsPetTalk.com-DexamethasonePetTalk.com-Triamcinolonesuch as cortisol are known to raise blood sugarMerck Veterinary Manual-Glucocorticoids and even sometimes cause diabetes. Talk to your vet -- sometimes steroids are still the best (or only) treatment for a condition and can be compensated for with known diabetes. Inhaled steroids for asthma may be tolerated by diabetics better than oral or injected. Using steroids--orally, injected or even topically (applied to the skin as an ointment or cream)--can elevate blood glucose levels. During treatment and for a period after treatment with steroids ends, higher doses of insulin may be necessary Steroid Treatment and Insulin NeedsPetPlace.com-Insulin-Precautions & Side Effects. *MoreCorticosteroid Brand Name List brand names for corticosteroids are : *'Prednisone'PetTalk.com-Prednisone *'Decadron' *'Kenalog' One brand name for injectable prednisone (methylprednisolonePetTalk.com-Methylprednisolone) is Depo-MedrolDepo-Medrol Drug Information. Many generic and brand name steroid medications, some with photo label links, are found on the Steroids page. Hormones *The drug Ovaban (megestrol acetate) (progestin--female hormone) is approved for use in dogs to end heat cycles. It has also been prescribed for behavioral problems in both dogs and cats, since it is the opposite of testosterone (male hormone). The drug has also been prescribed for some feline skin conditions. Its use with cats has been proven to cause diabetes much of the time; they are also at risk for developing Addison's disease as a result of the drug Use of Ovaban in Cats Can Lead to Health Problems. It is contraindicated for use in dogs with diabetes. These types of hormones, when prescribed for diabetics, can be "double problems". The progestin-type hormones themselves, by natureProgestin-type Hormones--Natural Body Action, raise blood glucose; use of them can also mean the body may begin producing excess growth hormones, which causes insulin resistance. Antibiotics *The antibiotic Tequin (gatifloxacin), has now been required to strengthen its labeling regarding hyperglycemia and hypoglycemia possibilities when usedFDA Warning Re: Tequin, Hyperglycemia & Diabetes. The new labeling contraindicates the antibiotic for anyone with diabetes. The producer of Tequin, Bristol-Meyers SquibbFDA Doctors' Letter Announcing Tequin's Discontinuation, indicated on May 1, 2006, that it plans to discontinue the manufacturing and distribution of Tequin. Current stocks of the antibiotic have NOT been recalled, so the drug is still on some medical/pharmacy shelves. Bristol-Meyers Squibb indicates they will continue to ship Tequin until June 1, 2006. A watchful eye on what antibiotic has been prescribed is needed. Antiarrhythmics/Heart/High Blood Pressure *'Verapamil', (human brand names: Calan, Covera, Isoptin, Verelan), is used to treat irregular heartbeats and hypertension (high blood pressure)Verapamil Drug Information-Medline. Despite there being no information at the preceding link regarding diabetes, this WSAVA 2003 presentationVerapamil Effects on Canine Blood Sugar & Triglycerides-WSAVA 2003 says it has serious hyperglycemic effects in dogs. The conclusion is that it should NOT be used for diabetics, because of its effects on blood sugar levels, possibly inducing hyperglycemic shock. The drug is in the calcium-channel blocker classEffect of Verapamil Dosage on Healthy Dog's ECG-WSAVA-2003 Warnings: May have other adverse side effects Antibiotics Our pets may be prescribed antibiotics for various reasons, such as a dental procedure or a urinary tract infection. *A common full-spectrum antibiotic given for dental procedures is Clavamox, which is available in both tabletClavamox Tablet Product Information and liquidClavamox Liquid Product Information form. The liquid form is sweet, but the sweetness is from an artificial sweetener and should not affect blood glucose. The pill can be crushed and added to wet food if the animal is difficult to pill. Some animals, like some humans, get diarrhea on antibiotics. This can be minimized by the concurrent administration of a probiotic like Culturelle Culturelle Information, which is available at vitamin stores. Consult with your veterinarian on the appropriate amount of probotic for your animal. Some caregivers report higher blood glucose levels while their pet is on antibiotics. *The antibiotic oxytetracyclinePetTalk.com-OxytetracyclineOxytetracycline and Insulin Use can cause low blood sugar or hypoglycemia. The medication Medline--Oxytetracycline/Terramycinis found in oral form under the (human) brand name Terramycin. The antibiotic is also able to be given by injection and found in ointment under the Terramycin brand name Terramycin Product Information and the (human) brand name TerakTerak-Ophthalmic-Drug Information for use in the eyes. *'Chloramphenichol'PetTalk.com-Chloramphenichol, brand name Chloromycetin, can lower blood glucoseChloramphenichol/Chloromycetin & Blood Glucose. It can also produce false urine glucose test resultsMerck Veterinary Manual-Chloramphenicol and Congeners-Special Clinical Concerns. *Another class of drugs used to fight various infections are called Sulfa DrugsPetTalk.com-SulfonamidesPetTalk.com-TrimethoprimPetTalk.com-Ormetoprim (many brand names--'Gantrisin', Septra, Bactrim are some-more at this linkMerck Veterinary Manual-Dose Rates of Sulfonamides). They are often used similarly to antibiotics for this purpose. SulfaSulfa Drugs by Brand Name & Hypoglycemia drugs can cause hypoglycemia, even in those without diabetes. They are also capable of altering urine glucose test resultsMerck Veterinary Manual-Sulfonamides and Sulfonamide Combinations-Special Clinical Concerns. Diuretics/Heart Medications *'Digoxin'PetTalk.com-Digoxin (aka Lanoxin and other brand names), furosemidePetTalk.com-Furosemide(aka Lasix, Salix, Myrosemide and other brand names), can interact with insulinDrugs Which Can Interact With Insulin. *Though its primary use is for treatment of diabetes, insulinUse of Insulin in Hyperkalemia Treatment is useful to both people and pets suffering from an overdose of potassium--too much of it in the blood. The medical term for this is hyperkalemiaPetPlace.com-Uses of Insulin. Potassium ions enter the cells through glucose--insulin helps bring this life-saving change about. *Regarding furosemide (human brand names Lasix & Myrosemide--veterinary brand name Salix) and bumetantide (human brand name Bumex, shown below), they belong to a class of directics known as loop diureticsAction of Loop Diuretics and Common Brand Names for Them. This type of medication can cause hyperglycemia for those with diabetes. Both digoxin and furosemide drain potassium from the system, along with the excess fluids they are prescribed to eliminate. Not all diuretics have this potassium-robbing action; those which don't are known as potassium-sparing diuretics. These drugs in combination with also necessary insulin can bring about a lower than normal potassium level known as hypokalemiaDigoxin & Hypokalemia. The problem can be prevented or solved by a prescription for a potassium suppliment (K-Dur is just one brand name). *Other diuretics such as bumantanideBumetanide (human brand name) Bumex Bumex and thiazide based diuretics/hypertension medicationsThiazide Based Diuretics/Hypertension Medications can cause hyperglycemia. There are many human brand names for this class of drugsBrand Names for Thiazide Based Medications at this link More Brand Names for Thiazide Based Medications. *More brand names for diuretics which can raise blood glucose levelsBrand Names of Diuretics Which Can Raise Glucose Levelsare: Diuril, hydroDIURIL,Esidrix, Diamox, Hygroton, Edicrin. *Hypertension drugs known generically as DiazoxideDiazoxide Drugs & Diabetes (Brand names: Hyperstat, Proglycem)are used not only for cases of high blood pressure, but also for treating non-diabetic hypoglycemia.This class of medication will raise blood glucose levels. *'Propanolol'PetTalk.com-Propanolol (human brand name Inderal)PetPlace.com-Insulin-Precautions & Side Effects is a drug used to fight hypertension (high blood pressure) and heart disease in people. The drug belongs to the beta-blocker class. They work by blocking beta receptors in the heart for noradrenaline and adrenaline. Anyone with diabetes using beta-blockersBeta-Blocker-type Drugs & Diabetes needs to be especially careful, because they also can block some of the normal symptoms of hypoglycemia and may make a hypoglycemic episode last longer Beta-Blockers & Hypoglycemia. Beta blockers increase the risk of hyperglycemia in those with diabetes. Other generic and human brand names of Beta-blockers are: acebutolol--'Sectral', atenolol--'Tenormin', betaxolol--'Kerlone', biprosolol--'Zebeta', carteolol--'Cartrol', labetalol--'Normodyne', metoprolol--'Lopressor', nadolol--'Corgard', oxprenolol--'Trasicor', penbutolol--'Levatol', pindolol--'Visken', propranolol--'Inderal', sotalol--'Sotacor', timolol--'Blocadren'Beta-Blockers by Brand & Generic Names. *'Carvedilol'Different Beta Blockers Produce Different Heart Rate Variability Patterns in Dogs-WSAVA 2005,human brand name CoregDrug Information Carvedilol/Coreg, a non-specific Beta-Blocker, can cause changes in blood sugar levels. *'Methyldopa'Methyldopa/Aldoril & Diabetes, brand name Aldoril, used in treating hypertension. can lower blood glucose levels. *'Verapamil' (Calan, Covera, Isoptin, Veralan) See Contraindications above for Antiarrthymics/Heart/High Blood Pressure. Causes hyperglycemia in dogs--can possibly precipitate a hyperglycemic crisis in canine diabetics. Antidepressants and Other Behavior-Modifying Drugs Many of the drugs commonly used for people are used for the same purposes in petsMerck Veterinary Manual-Psychotropic Agents. The following medications have been cited as having possible side effects in persons with diabetes: *'Prozac' AKA Sarafem- (Fluoxetine)-lowering blood glucoseRx List.com-change in insulin needsNational Institutes of Health-US-Fluoxetine-Prozac-Sarafem. *'Carbamazepine' AKA Atretol, Carbatrol, Epitol, Equetro, Tegretol, Apo-Carbamazepine, Novo-Carbamaz, Nu-Carbamazepine, Taro-Carbamazepine-also used for treatment of epilepsy may cause increased urine glucose levelsUS National Institutes of Health-Carbamazepine. *'Lithium' AKA Eskalith, Lithobid may either strengthen or weaken the effects of insulinRx List.com. *'Phenothiazines'-many generic and brand names at this linkUS National Institutes of Health-Phenothiazines-may reduce the blood-glucose lowering effect of insulinRx.com. Can Lower Blood Glucose *'Phenylbutazone'PetTalk.com-PhenylbutazonePhenylbutazone/Butazolidin & Diabetes, brand name, Butazolidin, used in treatment of arthritis, can lower glucose levels. * ChlofibrateChlofibrate/Atromid-S & Diabetes (Brand name Atromid-S), for high cholesterol. *'Aspirin'Aspirin & Low Blood Sugar/HypoglycemiaPetPlace.com-Insulin-Precautions & Side Effects can be a factor in low blood sugar, or hypoglycemia. *'Coumarin-based anticoagulants'Coumarin-based Anticoagulants & Low Blood Glucose/Hypoglycemia (Brand name Dicumerol), used to prevent blood clots. *'Prozac' AKA Sarafem- (Fluoxetine)-lowering blood glucoseRx List.com-change in insulin needsNational Institutes of Health-US-Fluoxetine-Prozac-Sarafem. *'Alcohol'Insulin Interactions with Other Drugs 7.6 can strengthen the blood glucose-lowering effects of insulin. Though our pets don't use alcohol as people do, there are medications and supplements both by prescription and OTC, which contain alcohol as part of their ingredientsBach Flower Therapy--WSAVA 2005. Reading labels carefully and being cautious when using meds containing alcohol can prevent possible hypos. For antibotics and sulfa drugs which lower blood glucose, see Antibiotics section above. All heart/hypertension/diuretics, some of which do lower blood glucose levels are also listed above in their own section. Other False Testing Results *'Antibiotics'Cephalexin/Kefle, Enrofloxacin/Baytril & Inaccurate Urine Glucose Testing in Dogs cephalexin (brand name Keflex)Cephalexin/Keflex Information and other cephalosporin antibiotics whose names appear at this linkMerck Veterinary Manual-Dose Rates of Cephalosporinsalong with enrofloxacinPetTalk.com-Enrofloxacin(brand name Baytril)Enrofloxacin/Baytril Information have been shown to provide less than accurate (false positives and false negatives) urine test resultsMerck Veterinary Manual-Cephalosporins and Cephamycins-Special Clinical Concerns (4 common OTC urine test kits used in study) when administered to non-diabetic dogs. When using either of these antibiotics and urine testing strips, the results may be totally inaccurate, thus invalidating their use for diabetes monitoring while said drugs are being used. *'Sulfa Drugs'PetTalk.com-SulfonamidesPetTalk.com-TrimethoprimPetTalk.com-Ormetoprim (many brand names--'Gantrisin', Septra, Bactrim are some-more at this linkMerck Veterinary Manual-Dose Rates of Sulfonamides). They are often used similarly to antibiotics for this purpose. SulfaSulfa Drugs by Brand Name & Hypoglycemia drugs are also capable of altering urine glucose test resultsMerck Veterinary Manual-Sulfonamides and Sulfonamide Combinations-Special Clinical Concerns. *'Chloramphenichol'PetTalk.com-Chloramphenichol, brand name ChloromycetinChloramphenichol/Chloromycetin & Blood Glucosecan also produce false urine glucose test resultsMerck Veterinary Manual-Chloramphenicol and Congeners-Special Clinical Concerns. *'Antibiotics' TetracyclinePetTalk.com-Tetracycline (human brand names Helidac, Sumycin) can cause false urine glucose test resultsTetracycline Medications & False Urine Test Results. DoxycyclinePetTalk.com-Doxycycline (human brand names Doryx, Doxy 100, Monodox, Vibramycin, Vibra-Tabs) can do the sameDoxycycline Medications & False Urine Test Results. Penicillin and its derivatives-'ampicillin', carbenicillin, ticarcillin, penicillin G and others shown at these linksMerck Veterinary Manual-Dose Rate of Penicillins-More Generic & Brand Names of Penicillin Family DrugsUS National Institutes of Health-Medline-Penicillins, can produce false positive urine glucose test resultsMerck Veterinary Manual-Penicillins-Special Clinical Concerns. *'Valproic Acid' (brand names Depakene, Depakote, Divalproex Sodium), most commonly used to treat epilepsy, can cause false urine ketone testing resultsUS National Institutes of Health-Medline-Valproic Acid. *Pets taking Vitamin CPetTalk.com-Vitamin CVitamin C & False Test Results in Petssupplements may have the following false test results: Blood Chemistry: * Decreased blood glucose and cholesterol test levels. Urine Testing: * False high urine glucose test results (With urine test brand name Clinitest). * False low urine glucose test results (With urine test brand name Clinistix). If your pet is taking any type of vitamin supplements, it should be noted on his or her medical records. Knowing that he/she is using them means being able to factor them into interpretations of test results. Further reading *Multidrug Sensitivities in Dogs--How They Can Be Gene-Related *Commonly Used Veterinary Drugs and Dosages By Species *Therapeutic Drug Monitoring--Tailoring Drug Dosages to the Individual Patient *Start Page to US Pharmacopeia--Information on Over 9,000 Rx & OTC Drugs *AnimalHelp.com-Veterinary Drug Database *Avoiding Adverse Drug Reactions-WSAVA 2001 References Category:ComplicationsCategory:TipsCategory:Treatments